Page 10 - CUA 2020_Functional Urology

Unmoderated Posters 3: Prostate Cancer, Functional Urology, Other Urology Topics

UP-3.14 tions, positive margin rate, local recurrence rate, disease-specific survival,
Patient perspectives on the value of WATChmAN (Web virtuAL and functional outcomes. Descriptive statistics were used to characterize
Testicular CANcer clinic) for clinical stage I patients on active our cohort, and to examine outcomes.
surveillance Results: Twelve men met study criteria with a median age of 62 years.
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Adam Bobrowski , Robert J. Hamilton , Lauren Landoni , Kopika Seven patients had failed prior treatment. The 90-day complication rate
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Kuhathaas , Peter Chung , Philippe L. Bedard , Padraig Warde , Aaron (Clavien-Dindo >2) was 0% and graft take was excellent in all cases. The
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Hansen , Tran Truong , Ezra Hahn , Michael A. Jewett , Jackie Bender 6 positive margins rate was 16.7% (n=2). Local recurrence occurred in two
1 Faculty of Medicine, University of Toronto, Toronto, ON, patients (16.7%), one of whom underwent a repeat organ-sparing surgery
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Canada; Departments of Surgery Departments of Surgery and Surgical for salvage, while the other underwent radical penectomy for high-risk
Oncology and Surgical Oncology (Urology), Princess Margaret pathological features. Disease-free survival at a median followup of 14
Hospital, University Health Network, University of Toronto, Toronto, months was 91.7% (11/12). Standing voiding and erectile function, as
ON, Canada; Department of Radiation Oncology , Princess Margaret well as satisfactory cosmesis were preserved in all patients.
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Hospital, University Health Network, University of Toronto , Toronto, Conclusions: Glansectomy with STSG reconstruction is a safe and effec-
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ON, Canada; Department of Medical Oncology, Princess Margaret tive treatment for men with localized penile cancer with simultaneous
Hospital, University Health Network, University of Toronto , Toronto, preservation of cosmesis, urinary, and sexual function.
ON, Canada; Techna Institute, University Health Network, University of
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Toronto, Toronto, ON, Canada; Cancer Rehabilitation and Survivorship UP-3.16
Program , Princess Margaret Hospital, University Health Network, Long-term outcomes of cecostomy tube insertion for patients
University of Toronto, Toronto, ON, Canada with bowel dysfunction: A retrospective review
Introduction: Adherence to stage I active surveillance (AS) schedules David W. Chapman , Steven Tong , Peter D. Metcalfe , Philippe Sarlieve ,
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can present compliance issues, as well as financial and logistical chal- Nathan Hoy , Darcie A. Kiddoo 1
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lenges for testicular cancer patients. We innovated a secure online plat- 1 Urology, University of Alberta, Edmonton, AB, Canada; Radiology and
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form, WATChmAN (Web-based virtuAl Testicular CANcer clinic) allowing Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
asynchronous communication between patients, results, and physician Introduction: Antegrade continence enemas are the standard treatment for
team. In this study, we explore patient perspectives regarding the value refractory fecal incontinence and constipation. Cecostomy tubes (CT) are
of virtual clinics. considered less invasive than Malone Antegrade Continence Enemas
Methods: Patients enrolled in the WATChmAN trial were invited to par- (MACE), but are associated with mechanical breakage, dislodgement,
ticipate in semi-structured telephone interviews to discuss their experi- and require annual changes. The aim was to describe the continence and
ence. Eligible patients had at least two interactions with virtual care. complication rates of CT insertion.
All interviews were audio recorded, transcribed verbatim, and analyzed Methods: A retrospective review was conducted on patients that under-
using thematic analysis. went insertion of CT for fecal incontinence. Demographics included age,
Results: All 13 eligible approached patients agreed to participate in an gender, presence of developmental delay, and etiology of bowel dys-
interview. This cohort was comprised of 46% seminoma and 54% non- function. Primary outcomes included continence rates and unplanned
seminoma patients. Subjects valued virtual care because it addressed exchanges. Secondary outcomes include number of anesthetics required
the logistical challenges they experienced with traditional care, specifi- and length of hospital (LOS) stay. Descriptive statistics and Student t-test
cally attending frequent appointments, long distance travel, parking, and was performed when appropriate.
wait times. While less than half (46%) believed they felt the same level Results: Forty-one patients were reviewed with a mean age of 9.9 years
of connection to their provider as they would with in-person visits, all and LOS of 3.47 days. Bowel dysfunction was a result of spina bifida
patients perceived the quality of care on the virtual care platform to be at (20/41), imperforate anus (13/41), functional (4/41), hypotonia/motor dys-
least equivalent. No patients had privacy concerns, nor did any cite any function (3/41), and a spinal cord tumor (1/41). Continence was achieved
challenges communicating with their healthcare team via virtual care. in 90% (37/41) of patients and failures were managed by conversion
Challenges with understanding medical jargon and laboratory values in to MACE (1/4) and distal insertion of a second cecostomy tube (2/4).
AS updates was common and often required explanation from the medical Unplanned CT exchanges occurred at least once in 73.2% (30/41), how-
team. Nearly all patients preferred to learn about disease relapse virtually, ever, the average rate of exchange was 1.3/patient/year. Developmental
but all wanted prompt face-to-face clinical followup with their provider delay, gender, and age at the time of insertion were not associated with an
to address questions. None of the patients believed virtual care could increase in complication rate. Patients required an average of 3.6 general
entirely replace face-to-face medical care. anesthetics (GAs) (range 0–15), and GAs were no longer required at the
Conclusions: Testicular cancer patients valued the convenience of vir- age of 14.9 years old (average). A laparotomy was required in two patients.
tual care AS and perceived their care to be of equivalent quality to Conclusions: CT insertion is a safe and effective method for the treat-
in-person visits. ment of fecal incontinence, however, unplanned exchange of tube due
to malfunction, mechanical breakage, or dislodgment occurs frequently.
UP-3.15 This data will ensure that families are counselled appropriately about
Management of localized penile cancer with an organ-sparing the long-term commitment that may be required to achieve a high rate
approach using split thickness skin grafting results in excellent of continence.
oncological and functional outcomes
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Benjamin Beech , David W. Chapman , Keith F. Rourke 1 UP-3.17
1 Division of Urology, University of Alberta, Edmonton, AB, Canada How should we measure the anteroposterior diameter (APD) of
Introduction: Penectomy as the traditional surgical treatment of penile the renal pelvis in congenital hydronephrosis?
cancer, has substantial adverse functional and psychological impact. Amr Hodhod , Francis Petrella , Mohamed El-Sherbiny , Iman Sadri ,
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Glansectomy with split thickness skin graft (STSG) reconstruction, aims Roman Jednak , J.-P. Capolicchio 1
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to provide curative resection while maximizing functional outcomes, and 1 Urology, McGill University Health Centre, Montreal, QC, Canada
minimizing psychological harm. We describe our outcomes of glansec- Introduction: APD is commonly used in hydronephrosis management.
tomy with STSG reconstruction for penile cancer in a Canadian setting. However, there is no consensus on the optimal APD measurement tech-
Methods: We identified patients undergoing glansectomy with STSG geni- nique, including whether it should be measured supine or prone. Some
tal reconstruction for squamous cell carcinoma of the penis from July suggest the APD should be measured at the intrarenal part of the renal
2006 to July 2019 at a single center. Patients undergoing glansectomy for pelvis, while others suggest that it should be done at the renal contour.
reasons other than penile cancer were excluded. We collected clinical This study evaluates six different techniques of APD measurements, in
and pathological data including patient demographics, 90-day complica-
CUAJ • June 2020 • Volume 14, Issue 6(Suppl2) S73